Difference Between PPO and POS

Today, more and more people are becoming health conscious. People are now considering the various options to assure themselves that they will be covered when it comes to times of sickness. In this regard, many managed health care plans come into play. If you have heard of the terms HMO, PPO and POS, then perhaps you are not that alien to these very commonly managed health care schemes. With regard to the last two plans mentioned above, the PPO is completely known as the Preferred Provider Organization, whereas the POS is the Point of Service Plan.

So what are the terms of the POS? The POS strategy is just like the HMO, because you have a primary care physician whom you can readily visit free of charge. You are free to go outside of your network of providers, even without visiting your primary care physician. However, you will have to pay a bigger sum per visit to each of the unaccredited (non POS) providers. Clearly, you can save more money if you just stay with the services from the providers within the POS network. You are also tasked to file for your reimbursement claims yourself for expenditures outside of the POS.

PPO, on the contrary, is an association of medical practitioners (like hospitals or doctors themselves) that render healthcare services to their target firm or group of clients. These PPO associations are either backed by stable organizations or big insurance companies. The key feature with PPO is that you no longer have to seek referrals from your primary care physician. Those who are members of the PPO also have the option to opt for providers (doctors) outside of the PPO network. Most often, the insurance company sponsoring your PPO will only reimburse the full amount of your expenses if you avail of PPO certified providers. Otherwise, you will only get back about 80% of what you have spent if you choose those medical practitioners who do not belong to your PPO association.

Moreover, one of the clear advantages of the PPO plan is that you have an ‘out of pocket expense’. This means that your expenditures must reach the maximum, or ceiling amount, for the insurance company to pay you the full expense cited in your PPO’s availment policies. Expenses like deductibles, as well as your payments for co-insurances, are included in this out of pocket expense cap. Obviously, your monthly insurance premiums are not counted.

Overall, both plans contribute to a more comprehensive approach to providing healthcare to their members. However, needless to say, just make sure that you consider all the options in terms of your plan’s coverage policies, costs and overall convenience of services. Here is a summary of the differences between PPO and POS plans.

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Written by : Julita.
and updated on March 12, 2010

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